ABS Pediatric Surgery common mistakes
ABS Pediatric Surgery · Understand the traps and how to avoid them.
For a fetus with a large neck mass or severe congenital diaphragmatic hernia, committing to a single prenatal diagnosis and describing only postnatal repair, without specifying delivery location, mode of delivery, or EXIT-team criteria.
Prenatal imaging is probabilistic and candidates anchor on the lesion name; they rehearse the operation but omit perinatal logistics that determine survival.
What to do instead
Use a structured prenatal counseling template every time: suspected diagnosis and differential, associated anomalies, prognostic markers, delivery hospital and mode, EXIT indications and team composition, and immediate neonatal stabilization pathway.
In a neonate with bilious emesis, ordering an upper GI contrast study before stating NG decompression, IV access, fluid resuscitation, glucose check, and antibiotics.
The diagnostic question dominates the candidate's thinking, so the time-critical stabilization sequence for possible malrotation/volvulus is skipped.
What to do instead
Verbalize a fixed sequence first: NPO, NG tube, IV access, isotonic fluid bolus, glucose and electrolytes, blood gas and lactate, antibiotics, then urgent upper GI or operative exploration.
In a 6-week-old with jaundice, selecting hepatobiliary scintigraphy as the first test instead of fractionated bilirubin, stool color assessment, and liver ultrasound.
Adult cholestasis habits and familiarity with HIDA scanning displace the pediatric biliary atresia algorithm.
What to do instead
Recite the biliary atresia pathway: fractionated bilirubin and stool color first, ultrasound next, HIDA only when the diagnosis remains unclear, and liver biopsy for confirmed or highly suspected cases.
Recommending upfront resection of a large abdominal mass with image-defined risk factors or intravascular thrombus, without stating the need for biopsy, staging, and neoadjuvant chemotherapy.
A surgical mindset favors immediate removal, and candidates underestimate how neoadjuvant therapy changes resectability and outcomes in pediatric solid tumors.
What to do instead
State tumor type and stage first, list image-defined risk factors, then give the protocol-specific sequence of biopsy versus resection, lymph node sampling, and neoadjuvant or adjuvant therapy.
In a pre-mobile infant with a femur fracture and bruising, completing an orthopedic plan without initiating a non-accidental trauma evaluation.
The visible injury captures attention, and candidates treat the fracture rather than the mechanism and developmental stage.
What to do instead
Make a non-accidental trauma screen mandatory for any pre-mobile infant with a fracture: skeletal survey, head imaging, retinal examination, careful history, and child protection involvement.
Treating a child with loculated empyema with antibiotics alone and no plan for drainage or escalation.
Candidates focus on the infectious diagnosis and underestimate the fibrinopurulent stage, where antibiotics cannot clear the pleural space.
What to do instead
State the staged management plan: chest tube and fibrinolytics for loculated collections, VATS when drainage fails, and antibiotics as an adjunct rather than the sole therapy.
Describing a PSARP for a newborn with imperforate anus without stating VACTERL screening, renal and spinal imaging, cardiac evaluation, or the timing of colostomy for a high lesion.
The anorectal anatomy dominates the answer, and associated anomalies that determine morbidity are omitted.
What to do instead
Use a VACTERL checklist every time: cardiac echocardiogram, renal ultrasound, spinal ultrasound or MRI, and a clear plan for colostomy versus primary repair based on lesion height and stability.
Planning simple excision of a solid thyroid nodule in a child without first obtaining thyroid ultrasound and ultrasound-guided fine-needle aspiration.
Candidates assume pediatric thyroid nodules are benign and transfer adult soft-tissue habits without applying the higher pediatric malignancy risk.
What to do instead
State ultrasound characterization and FNA as the first steps, interpret results using the Bethesda system, and involve a high-volume endocrine surgeon when malignancy is suspected.
Prescribing adult-style isotonic maintenance fluids without dextrose in a 2-day-old postoperative neonate.
The 4-2-1 rule is overlearned, and candidates forget that neonates have limited glycogen stores and higher insensible losses.
What to do instead
Use neonatal maintenance fluids with dextrose, adjust sodium and free water for gestational age and ongoing losses, and check glucose and electrolytes after any fluid change.
In a newborn with respiratory distress and a left-sided congenital diaphragmatic hernia, giving bag-mask ventilation and delaying intubation or NG decompression.
Candidates treat respiratory distress generically and forget that positive-pressure bagging worsens bowel distension and pulmonary compression in CDH.
What to do instead
State immediate intubation without bag-mask ventilation, NG decompression, gentle ventilation, and avoidance of acidosis, then proceed to stabilization and delayed repair.